Tubal Risk Factor Screening
Tubal Risk Factor Screening tests for infections that can cause damage to the fallopian tubes, resulting in infertility and increasing the risk of ectopic pregnancy.
What is Tubal Risk Factor Screening?
For natural conception to occur, the egg must travel from the ovary through the fallopian tube, where fertilisation takes place before the embryo reaches the uterus.
Certain sexually transmitted infections (STIs), particularly chlamydia and gonorrhoea, can lead to pelvic inflammatory disease (PID). In some cases, this may result in scarring or blockage of the fallopian tubes, which can affect fertility and increase the risk of ectopic pregnancy.
Because these infections often cause few or no symptoms, Tubal Risk Factor Screening is used to identify current infection and ensure appropriate treatment can be provided if required.
The screening test does not assess whether the fallopian tubes are open. If there is concern about tubal damage or blockage, further investigations, such as a HyCoSy, may be recommended.
What to Expect?
Tubal Risk Factor Screening is a simple urine test used to check for chlamydia and gonorrhoea, two common sexually transmitted infections that can affect fertility.
These infections can sometimes damage the fallopian tubes without causing obvious symptoms. Identifying a history of infection can help assess your risk of tubal disease and determine whether further investigations, such as a HyCoSy tubal assessment, may be recommended.
The test is quick and non-invasive. A urine sample is collected at the clinic and sent to a specialist laboratory for analysis.
FAQs
Why is tubal risk factor screening part of a fertility investigation?
Tubal risk factor screening is an assessment that helps us understand the likelihood that your fallopian tubes have been affected by past infection or inflammation. The fallopian tubes are where fertilisation takes place, and damage to them is one of the most common and significant causes of female infertility.
The challenge with tubal damage is that it is frequently silent. Many of the infections and conditions that can cause lasting harm to the tubes produce no symptoms at the time, meaning a woman may have no idea her tubes have been affected until she tries to conceive. Tubal risk factor screening allows us to identify those at higher risk of tubal damage before committing to a treatment pathway, so that appropriate further investigation can be arranged.
At Genus Fertility, this screening forms part of your initial fertility assessment. It helps us decide whether a direct tubal patency test such as a HyCoSy is warranted, and ensures that tubal factors are not overlooked as a potential cause of your fertility difficulties.
Why does a past chlamydia infection matter if it was treated at the time?
This is one of the most important questions in tubal health, and the answer surprises many people. Chlamydia trachomatis is the most common sexually transmitted infection in the UK, and between seventy and eighty per cent of women who contract it have no symptoms at all. That means the majority of infections go undetected and untreated, sometimes for years.
Even when chlamydia is treated with antibiotics, the treatment clears the active infection but cannot reverse any damage that has already been done to the fallopian tubes. The bacteria invade the delicate inner lining of the tubes, triggering inflammation that, over time, leads to scarring and adhesion formation. This process can result in partial or complete blockage, or in more subtle damage that impairs tubal function even without causing a full blockage.
The chlamydia antibody test detects IgG antibodies that can remain in the blood for many years after an infection, even after successful antibiotic treatment.
What other factors increase the risk of tubal damage?
Chlamydia is the most common cause, but it is not the only one. Several other conditions and events are associated with tubal damage.
Pelvic inflammatory disease (PID) is an infection of the upper reproductive tract, most often caused by chlamydia or gonorrhoea, that can cause significant inflammation and scarring of the fallopian tubes. Even a single episode of PID that was treated promptly carries some risk of lasting tubal damage.
Ectopic pregnancy, where an embryo implants in the fallopian tube rather than the uterus, is both a consequence and a cause of tubal damage. A history of ectopic pregnancy indicates that at least one tube may have been affected, and the treatment of an ectopic pregnancy can itself cause further scarring.
Endometriosis can involve the fallopian tubes directly or cause peritubal adhesions that restrict tubal movement and function, even without causing a blockage as such.
Previous pelvic or abdominal surgery of any kind carries a small risk of adhesion formation, which can indirectly affect the tubes.
If my tubes might be damaged, does it mean IVF is my only option?
Not necessarily. The most appropriate treatment depends on the extent of tubal damage, your age, ovarian reserve, how long you have been trying to conceive, and whether any other fertility factors are present.
If one fallopian tube is open and functioning normally, natural conception may still be possible. In these circumstances, some couples may choose to continue trying naturally, whilst others may benefit from fertility treatment depending on their individual situation.
Where there is significant damage to both fallopian tubes, IVF is usually the most effective treatment because it bypasses the tubes altogether. In selected cases, further investigations or surgical treatment may be considered, although this is not appropriate for everyone.
Following your assessment, your fertility specialist will discuss your results in detail and help you understand the options available, allowing you to make an informed decision about the next steps.